Friday, April 24, 2009

Charles Krauthammer thinks he's found the perfect way to put the fear of God into us when it comes to Barack Obama's health plans: write an article in which the word "rationing" is repeated as often as the English language allows. Ten times he warns us that Obama's universal coverage plans will involve rationing:

The hard part is Medicare and Medicaid. In an aging population, how do you keep them from blowing up the budget? There is only one answer: rationing.

Why do you think the stimulus package pours $1.1 billion into medical "comparative effectiveness research"? It is the perfect setup for rationing. Once you establish what is "best practice" for expensive operations, medical tests and aggressive therapies, you've laid the premise for funding some and denying others.

But this is a peculiar definition of "rationing." I'd always thought rationing was supposed to mean denying or postponing needed care based upon fiscal constraints. But for Krauthammer, "rationing" includes such reasonable ideas as focusing health spending on the most effective treatments and avoiding those that are less effective. Why anyone would oppose such a common sense approach to spending (and its common sense not only for health care spending, but for spending in general) I'm not sure. After all, is "comparative effectiveness research" really substantially different from a competitive bidding process, in which the government examins all bids (or in this case drugs) and chooses the one that meets design objectives (cures the disease) for the least amount of money?

Now, I will say that unlike most conservatives, Krauthammer is at least willing to admit that we have health care rationing in this country already. Sadly, the examples he gives of this are ludicrously rare:

Rationing is not quite as alien to America as we think. We already ration kidneys and hearts for transplant according to survivability criteria as well as by queuing.

OK, but what about the 47 million Americans who have no health insurance? Why does Krauthammer completely ignore them? I'd say that's a far broader pool of individuals for whom rationing is not just a theoretical issue, people who often do without needed treatments or doctor visits because they simply cannot afford them.

My own preference is for a highly competitive, privatized health insurance system with a government-subsidized transition to portability, breaking the absurd and ruinous link between health insurance and employment.

Krauthammer's solution is really a non-solution. He wants "portable" health insurance, which sounds nice until you realize that he just wants employers to be able to free themselves of the burden of providing health care for their employees. This cost, as Krauthammer notes, has proved ruinous to the U.S. economy by making our manufacturing sector uncompetitive (at least that's what I assume he means when he refers to the costs as ruinous). But why Krauthammer thinks that individuals with no group bargaining power could possibly afford health insurance that a business cannot is a mystery. I guess the magic of the free market will just make things "work out."

As with most conservative approaches to health care, Krauthammer's solution isn't. Personally, my sense is that conservatives want a "free market" solution knowing that once insurance companies are freed of all government constraint and regulation, they'll be able to cherry pick their customers, denying coverage to people with chronic illnesses or who have been shown genetically pre-disposed to expensive conditions, and offering cheap coverage to those who are healthy and likely to remain healthy. At any given time, most people will have cheap health insurance, but a sizable minority will be unable to afford any coverage at all. They will live miserable lives dealing with illnesses they cannot afford to treat, and bankrupting themselves between hospital visits. It's just that this pool of hapless victims will be too small to pose an electoral threat to the GOP. The conservative solution is basically just a heartless social Darwinism.

1 comment:

> It's just that this pool of hapless victims will be too small to pose an electoral threat to the GOP.

What gets called "medical insurance" in the United States will quickly only be available for healthy people between the ages of 18 to 38, and people making at least $100,000 a year. Since these people will have the whole rest of their family members ineligible, even _they_ will not stand for so-called "free-market" health care.

The right-wing is simply announcing that they have no interest in participating in the health-care debate. The same way that a person wearing a suit made from dirty newspapers and string is announcing they don't want anyone sitting next to them on the bus.

They cheered the Iraq invasion right up to the very day it proven electoral suicide. They are determined to do the exact same with "free-market" health care.